Laserfiche WebLink
ONSITE W' "TE WATER TREATMENT SYSTEM PERK RTT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEJI DEPARTMENT 304EWEBERAVE-3'°a-S'. j)T1 CA 95202-(209)46&3420 <br /> NON-REFUNDABLE PERMIT CALL 209 953-7697FdRINSPECTIONS EXPIRENYEAR FROM DATE ISSUED <br /> JOB ADDRESS / '"J-. '•,�•-J Cltt/Zle ,. i ,I ) '' :4> <br /> CRUSH SFRcer � APN <br /> /.^Y Ay) <br /> r OWNERNAME -"/n PHONE <br /> OWNERADDRESS CITY/STATFJZIP / <br /> CONTRACTOR II PHONE <br /> CONTMCTORADDREES <br /> LICENSE ❑C42 ❑C-J6 OTHER NUMBCR EXPIMTION DALE <br /> WATERTABLEDEEIH: fl GEOGRAPHICALINFORMATION: C.PrU bo % Y <br /> ❑ PERU TEST M N . BUILDING PERMIT# LAND USE APPLICATION# <br /> r <br /> TYPE OF WORK:- ❑ --n-ALL-ION" - ❑ REPAIR/ADDITION - ❑ ENGINEERDFSICNED/ALTEWYATVE <br /> ❑ REPLACEMENT - ❑ DESTRUCTION <br /> INSTALLATION WILLSERVE: ❑ RTs1DENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEOPOOMS: NUMBEROFEMELOYEFS: <br /> r <br /> ❑ SEPTIC TANK T1 PE/MFG CnPACTrc P1 pOF COMPARTMENf9 <br /> ❑ GRE.ASETRAP TYFDMFG CAPACITY pl #OFCOMPARTSmNTS <br /> ❑ FEE TX PLANT DDTANCE1ONE1RE4: WELL 0 FOUNDATION - R PROPERrr ENE fl <br /> �- ❑ LIFT STATION SUDE TYPEOPPU.r ❑ SAND OIL SEPARATOR(ENCLOSEp SYSTEM) <br /> ❑ LEACH LINES ❑ LEACHING CHAMBERS #OFLNES LENGTHOFLINES ft <br /> DISrANCETONEAREST WELL _R FOUNDATION fl PROPERTYLNE R <br /> j ❑ FILTER RED WIDTH _____ft LENGTH I ft DEPTH ft <br /> DISTANCETONEARESr WELL - ft FOUNDATION ft PROPERTY I. - ft <br /> ❑ MOUNDED WIDTH _ft LLNGTx_ fl - DEPTH R IN <br /> DISTANCE TO NEAREST WFU- ft FONJDATION 0 PROPERTY ENE R W <br /> ❑ SUMPS WmTx _ ft LENGTH -" - - ft DEPTH- R <br /> w j )DISI'ANCETONEAREST WELL R FOUNDATION R PROPERTY LINE R <br /> ❑ DISPOSAL PONDS WIDTH__ft LENGTH R DEPTH It '/- <br /> DISTANCETONEAREST WELL ft FOUNDATION R PROPERTY LINE R m <br /> ❑ SEEPAGE PITS NUMBER WlDrx R DEPTH ft <br /> -DISTANCETONEARE51' - WELL, R FOUNDATION - R - PROPERTYNIE R <br /> ` I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITHSANJOAQURI COUNTY <br /> ORDINANCES,STATE LAWS AND RULESAND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> Al ININUM 24 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS PLEASE CALL(209)953-7697 <br /> r SIGNED I TITLE DATE 'f\J <br /> o # <br /> nr �9 v 16' <br /> ae <br /> r 1 ar Pzo"ErL s <br /> Eoe ora '^n'rfz2rev # o <br /> n9ROm. IrARC�� PARCEL amp REMEAwB <br /> r PARC. ) _n o <br /> A -vm ro�+�uMnr <br /> m ur <br /> a M x <br /> tw2 <br /> r -------- <br /> 144H E M <br /> DEPARTMENTUE 9NLY [/ <br /> r Application Accepted By oL -- Dale � p7DS Area Employee IDII SSV-T /fjL <br /> Final Inspection By Date - ❑ SPECIAL PERMIT-Approved by / <br /> Cha.Wr of SOR to Depth of 3 FU PIUSump Sall Cbmcter: <br /> r COMMENTS <br /> PE SC Received Chealda/ Amount Dvte mPMld Involve# Percrat Im <br /> IRB I Cade INE. B Io mined S. Reamotit <br /> v�.az S2/ 11 7'110 3'72.t.J 4 £CS S'J'ur, 4 z L:a <br /> 42-02-001 ONSITE WASTEWATER PERMIT <br /> Iv2v2DDF <br />